Participate in Liver Research

Explore clinical research studies in Columbus Ohio for people with Liver Disease.

Complete this short survey to see if you qualify

Please tell us about yourself so that we can find suitable study locations near you. All the information you complete will remain private.

First Name

Last Name

Primary Phone

Mobile Phone

Address

Apt. / Ste.

City

Zip Code

We need this information calculate your body mass index (BMI).

Height (Feet)

Height (Inches)

Weight (lbs)

Date of Birth

Gender

Male Female Other

Please choose the race and/or ethnicity that describes yourself. Choose all that apply:

Have you been diagnosed with, or suspected to have liver disease?

Yes No

Do you have any of the following health conditions?

Cancer in the last 5 years Poorly controlled diabetes (i.e., not on any treatment) Allergies to medications such as opioids, NSAIDS, etc Cardiac Disease (e.g., myocardial infarction, seizures, stroke, etc.) Kidney Disease Respiratory disease (such as COPD, history of P.E., etc.) History of HIV, Hepatitis B, or Hepatitis C

How did you hear about us?

Your privacy is important to us. Please confirm that you have reviewed our Privacy Policy and agree to the Terms of Use.

Yes, I have reviewed the privacy policy and agree to terms of use